Abigail A. Dumes, What Long Covid Shows Us About the Limits of Medicine, The New York Times, March 17 2022
Long Covid symptoms, such as fatigue, shortness of breath, cognitive difficulties, erratic heart rate, headache and dizziness, can be debilitating and wide-ranging. There is uncertainty about what ultimately causes long Covid and how to adequately respond to it.
In conventional medicine, illnesses without definitive markers of disease are often described as “medically unexplained.” As a medical anthropologist who has studied the controversy over whether treated Lyme disease can become chronic, I’ve been struck by the similarities between long Covid and other contested illnesses like chronic Lyme disease and myalgic encephalomyelitis, more familiarly known as chronic fatigue syndrome.
At the heart of conventional medicine is a foundational distinction between symptoms and signs. Symptoms like fatigue and joint pain are subjective markers of disease, while signs like fever and arthritis are considered objective markers. Unlike symptoms, signs can be observed and measured by a practitioner, often with the aid of technologies such as blood tests and radiologic imaging.
When it comes to making a diagnosis, signs trump symptoms. This enduring hierarchy can be traced to the late 18th and early 19th centuries in the United States and Europe, when physicians who had relied on external symptoms for diagnosis shifted to a focus on internal anatomy and pathology by using technologies like microscopes. The French philosopher Michel Foucault observed that during that time, medicine transitioned from a practice in which the physician asked, “What’s the matter with you?” to a practice in which the physician asked, “Where does it hurt?” The first question invites a patient’s description of symptoms; the second question leads to a location on the patient’s body that can be observed and measured by the physician.